CHEST RADIOLOGY <ul><li>Prepared By : </li></ul><ul><li>Belal Alrefaei </li></ul><ul><li>Merry Admaso </li></ul><ul><li>Bs...
The 12-Step: <ul><li>1:  Name </li></ul><ul><li>2:  Date </li></ul><ul><li>3 :  Old films </li></ul><ul><li>4 :  What type...
Chest X-Ray Findings <ul><li>Is heart enlarged or normal?  </li></ul><ul><li>Signs of heart failure and fluid overload?  <...
NORMAL CHEST X-RAY PA LATERAL Two (2) projections are needed for most x-rays to locate structures in 3 planes  (1)Right or...
NORMAL HEART BORDERS Note cardiac chambers that account for margins on the chest X-ray
<ul><li>R Atrium </li></ul><ul><li>R Ventricle </li></ul><ul><li>3.  Apex of L Ventricle </li></ul><ul><li>Superior Vena C...
LEFT 4 TH  RIB   POSTERIOR  AND  ANTERIOR  PORTIONS POSTERIOR ANTERIOR 4 A P
AORTIC ARCH LT. HEMI DIAPHRAGM NORMAL CHEST   ANATOMY LATERAL CHEST XRAY COLON GAS TRACHEA OBLIQUE FISSURE HORIZONTAL FISS...
CARINA LT. MAIN BRONCHUS RT. MAIN BRONCHUS TRACHEA OBLIQUE FISSURE (major) OBLIQUE FISSURE major HORIZONTAL FISSURE minor ...
HORIZONTAL FISSURE FISSURES DIVIDE  LUNGS INTO LOBES RIGHT  lung has: UPPER  MIDDLE  lobes LOWER LEFT  lung has: UPPER  lo...
<ul><li>INTERESTING  CASES </li></ul>INFECTION NEOPLASTIC CARDIOVASCULAR TRAUMA
 
<ul><li>RUL pneumonia </li></ul>
<ul><li>RML pneumonia </li></ul>
<ul><li>RLL pneumonia </li></ul>
<ul><li>LUL pneumonia </li></ul>
<ul><li>LLL pneumonia </li></ul>
<ul><li>Pulmonary Fibrosis </li></ul>
<ul><li>Miliary TB </li></ul><ul><li>Snow Storm Apperance </li></ul>
TB
<ul><li>Cavitating lesion </li></ul>
CaVity
<ul><li>Hilar Lymphadenopathy - BL </li></ul>
PNEUMOTHORAX PLEURAL EFFUSION
PLEURAL EFFUSION NORMAL
PLEURAL EFFUSION
<ul><li>Pleural Effusion </li></ul>
Bilateral pleural effusions
PNEUMOTHORAX
<ul><li>Pneumothorax </li></ul>
TENSION PNEUMOTHORAX
TENSION PNEUMOTHORAX
Hyperinflation
Hemothorax
Aortic dissection with hemothorax
<ul><li>RUL collapse </li></ul>
<ul><li>LLL collapse </li></ul>
Chest mass, emphysema Hilar mass
<ul><li>Emphysema </li></ul>
Subcutaneous emphysema
ARDS <ul><li>Congestion </li></ul><ul><li>Interstitial and alveolar edema </li></ul><ul><li>Collapsed or distended alveoli...
Bulla
SARCOIDOSIS <ul><li>Granulomatous Inflammation </li></ul><ul><li>Bilateral & symmetrical hilar & mediastinal LAD </li></ul...
ATELECTASIS <ul><li>No ventilation to lobe beyond the obstruction   </li></ul><ul><li>Trapped  air absorbed by pulmonary c...
NORMAL HEART  CARDIOMEGLY
<ul><li>Dextrocardia </li></ul>
Cardiomegaly Cardiac silhouette greater than 50% of width of thorax
CARDIOMEGLY CONGESTIVE   HEART FAILURE Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ven...
Congestive Heart Failure <ul><li>Increased heart size:  cardiothoracic ratio  >0.5 </li></ul><ul><li>Large hila with indis...
<ul><li>Heart failure </li></ul>
Pericardial effusion
Pulmonary Edema
Pulmonary Embolism
Kerley B line
VSD
ASD
Tetrology Of Fallot (Boot Shaped)
Aortic dissection
<ul><li>Multiple Masses </li></ul>
Free air Free air beneath diaphragm
<ul><li>Air under the diaphragm </li></ul>
Empyema after trauma Clavicle fracture Cavitary lesion Opacified hemithorax
Pneumonectomy
Pneumonectomy Entire mediastinum shifted left, indicating  volume loss Opacified left hemithorax Trachea shifted left, ind...
<ul><li>Hiatus hernia </li></ul>
PULMONARY METASTATIC NODULES
Clavicle dislocation Medial clavicle is displaced inferiorly
Clavicle fracture, distal
LT. Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with no...
FRONTAL LATERAL WHAT AND WHERE IS IT? Air stripe Coin in esophagus shows a wider diameter than possible in the trachea and...
Diaphragm rupture
Smoke inhalation, chronic changes
 
Right Lower Lobe Pneumonia
Right side tension pneumothorax
Fracture of posterior rib #7
Right Side Pleural Effusion
Left Sided Pneumothorax
 
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Chest xray

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  • Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2)Anterior or Posterior) or (3) Superior or Inferior.
  • Note cardiac chambers that account for margins on the chest X-ray
  • This exam shows barium contrast outlining the bronchial tree. This is an old exam not done now with CT imaging replacing it. It does demonstrate the anatomy of the hila which superimpose over the pulmonary arteries and veins. This is why anatomy here on the chest X-ray is difficult in this region.
  • With heart failure edema builds up in lungs and edema along fissures allows them to be seen more easily on chest x-ray
  • Pleural effusion developing on the left
  • Air in the pleural space separates the visceral and parietal pleura. This limits effective ventilation of the lung.
  • Here air has built up under pressure in the pleural space and collapsed the lung severely compromising ventilation. The pressure builds due to a ball valve type leak of air into the pleural space with air going into the space on each inspiration.
  • Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
  • Multiple lesions in the chest are typical for metastatic disease since the pulmonary capillary bed is often the first site metastatic lesions appear as they spread and embolize the pulmonary capillaries and grow in the new location.
  • Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
  • Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.
  • Chest xray

    1. 1. CHEST RADIOLOGY <ul><li>Prepared By : </li></ul><ul><li>Belal Alrefaei </li></ul><ul><li>Merry Admaso </li></ul><ul><li>Bshara </li></ul>
    2. 2. The 12-Step: <ul><li>1: Name </li></ul><ul><li>2: Date </li></ul><ul><li>3 : Old films </li></ul><ul><li>4 : What type of view(s) </li></ul><ul><li>5 : Penetration </li></ul><ul><li>6 : Inspiration </li></ul><ul><li>7 : Rotation </li></ul><ul><li>8 : Angulation </li></ul><ul><li>9 : Soft tissues / bony structures </li></ul><ul><li>10 : Mediastinum </li></ul><ul><li>11 : Diaphragms </li></ul><ul><li>12 : Lung Fields </li></ul>Quality Control Findings } } Pre-read }
    3. 3. Chest X-Ray Findings <ul><li>Is heart enlarged or normal? </li></ul><ul><li>Signs of heart failure and fluid overload? </li></ul><ul><li>Does patient have pneumonia or collapsed lung? </li></ul><ul><li>Is there evidence of emphysema? </li></ul><ul><li>Are there findings of an aortic aneurysm? </li></ul><ul><li>Is there fluid in the sac that surrounds the lung? </li></ul><ul><li>Is there free air under the diaphragm? </li></ul><ul><li>Is there a tumor in the lung that could represent cancer? </li></ul>
    4. 4. NORMAL CHEST X-RAY PA LATERAL Two (2) projections are needed for most x-rays to locate structures in 3 planes (1)Right or Left , (2) Anterior or Posterior) or (3) Superior or Inferior.
    5. 5. NORMAL HEART BORDERS Note cardiac chambers that account for margins on the chest X-ray
    6. 6.
    7. 7. <ul><li>R Atrium </li></ul><ul><li>R Ventricle </li></ul><ul><li>3. Apex of L Ventricle </li></ul><ul><li>Superior Vena Cava </li></ul><ul><li>Inferior Vena Cava </li></ul><ul><li>6. Tricuspid Valve </li></ul><ul><li>Pulmonary Valve </li></ul><ul><li>Pulmonary Trunk </li></ul><ul><li>9. R PA 10. L PA </li></ul>
    8. 8. LEFT 4 TH RIB POSTERIOR AND ANTERIOR PORTIONS POSTERIOR ANTERIOR 4 A P
    9. 9. AORTIC ARCH LT. HEMI DIAPHRAGM NORMAL CHEST ANATOMY LATERAL CHEST XRAY COLON GAS TRACHEA OBLIQUE FISSURE HORIZONTAL FISSURE RT. HEMI DIAPHRAGM Diaphragm-AP view Diaphragm- Lateral view LT. LT. RT. LT.
    10. 10. CARINA LT. MAIN BRONCHUS RT. MAIN BRONCHUS TRACHEA OBLIQUE FISSURE (major) OBLIQUE FISSURE major HORIZONTAL FISSURE minor BRONCHOGRAM—CONTRAST OUTLINING AIRWAY
    11. 11. HORIZONTAL FISSURE FISSURES DIVIDE LUNGS INTO LOBES RIGHT lung has: UPPER MIDDLE lobes LOWER LEFT lung has: UPPER lobes LOWER
    12. 12.
    13. 13. <ul><li>INTERESTING CASES </li></ul>INFECTION NEOPLASTIC CARDIOVASCULAR TRAUMA
    14. 15. <ul><li>RUL pneumonia </li></ul>
    15. 16. <ul><li>RML pneumonia </li></ul>
    16. 17. <ul><li>RLL pneumonia </li></ul>
    17. 18. <ul><li>LUL pneumonia </li></ul>
    18. 19. <ul><li>LLL pneumonia </li></ul>
    19. 20. <ul><li>Pulmonary Fibrosis </li></ul>
    20. 21. <ul><li>Miliary TB </li></ul><ul><li>Snow Storm Apperance </li></ul>
    21. 22. TB
    22. 23.
    23. 24. <ul><li>Cavitating lesion </li></ul>
    24. 25. CaVity
    25. 26. <ul><li>Hilar Lymphadenopathy - BL </li></ul>
    26. 27. PNEUMOTHORAX PLEURAL EFFUSION
    27. 28. PLEURAL EFFUSION NORMAL
    28. 29. PLEURAL EFFUSION
    29. 30. <ul><li>Pleural Effusion </li></ul>
    30. 31. Bilateral pleural effusions
    31. 32. PNEUMOTHORAX
    32. 33. <ul><li>Pneumothorax </li></ul>
    33. 34. TENSION PNEUMOTHORAX
    34. 35. TENSION PNEUMOTHORAX
    35. 36. Hyperinflation
    36. 37. Hemothorax
    37. 38. Aortic dissection with hemothorax
    38. 39. <ul><li>RUL collapse </li></ul>
    39. 40. <ul><li>LLL collapse </li></ul>
    40. 41.
    41. 42. Chest mass, emphysema Hilar mass
    42. 43. <ul><li>Emphysema </li></ul>
    43. 44. Subcutaneous emphysema
    44. 45. ARDS <ul><li>Congestion </li></ul><ul><li>Interstitial and alveolar edema </li></ul><ul><li>Collapsed or distended alveoli </li></ul><ul><li>Bilateral </li></ul>
    45. 46. Bulla
    46. 47. SARCOIDOSIS <ul><li>Granulomatous Inflammation </li></ul><ul><li>Bilateral & symmetrical hilar & mediastinal LAD </li></ul><ul><li>Generalized fibrosis </li></ul>
    47. 48. ATELECTASIS <ul><li>No ventilation to lobe beyond the obstruction </li></ul><ul><li>Trapped air absorbed by pulmonary circulation </li></ul><ul><li>Segmental/lobar density </li></ul><ul><li>Compensatory hyper-inflation of normal lungs. </li></ul>
    48. 49.
    49. 50.
    50. 51. NORMAL HEART CARDIOMEGLY
    51. 52. <ul><li>Dextrocardia </li></ul>
    52. 53.
    53. 54. Cardiomegaly Cardiac silhouette greater than 50% of width of thorax
    54. 55. CARDIOMEGLY CONGESTIVE HEART FAILURE Evolution of congestive heart failure and pulmonary edema. With Progressive Lt. Ventricular failure blood backs into the left atrium—then to the pulmonary veins (PULMONARY VENOUS HYPERTENSION) then to the pulmonary interstitium (INTERSTITIAL EDEMA) then to the alveoli (ALVEOLAR EDEMA)
    55. 56. Congestive Heart Failure <ul><li>Increased heart size: cardiothoracic ratio >0.5 </li></ul><ul><li>Large hila with indistinct markings </li></ul><ul><li>Fluid in interlobar fissures </li></ul><ul><li>Pleural effusions, alveolar edema </li></ul>
    56. 57. <ul><li>Heart failure </li></ul>
    57. 58. Pericardial effusion
    58. 59. Pulmonary Edema
    59. 60. Pulmonary Embolism
    60. 61. Kerley B line
    61. 62. VSD
    62. 63. ASD
    63. 64. Tetrology Of Fallot (Boot Shaped)
    64. 65. Aortic dissection
    65. 66.
    66. 67. <ul><li>Multiple Masses </li></ul>
    67. 68. Free air Free air beneath diaphragm
    68. 69. <ul><li>Air under the diaphragm </li></ul>
    69. 70. Empyema after trauma Clavicle fracture Cavitary lesion Opacified hemithorax
    70. 71. Pneumonectomy
    71. 72. Pneumonectomy Entire mediastinum shifted left, indicating volume loss Opacified left hemithorax Trachea shifted left, indicating volume loss
    72. 73. <ul><li>Hiatus hernia </li></ul>
    73. 74. PULMONARY METASTATIC NODULES
    74. 75. Clavicle dislocation Medial clavicle is displaced inferiorly
    75. 76. Clavicle fracture, distal
    76. 77. LT. Rib fracture on the left are associated with a small pleural effusion blunting the costophrenic angle. Compare with normal RT. side.
    77. 78. FRONTAL LATERAL WHAT AND WHERE IS IT? Air stripe Coin in esophagus shows a wider diameter than possible in the trachea and is posterior to the tracheal air stripe on the lateral chest x-ray.
    78. 79. Diaphragm rupture
    79. 80. Smoke inhalation, chronic changes
    80. 82. Right Lower Lobe Pneumonia
    81. 83. Right side tension pneumothorax
    82. 84. Fracture of posterior rib #7
    83. 85. Right Side Pleural Effusion
    84. 86. Left Sided Pneumothorax
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